Spatial variation, 20-year trends, and determinants of the double burden of wasting and stunting among under-five children in Ethiopia: a geo-spatial and multivariate decomposition analysis (2000-2019).

Despite extensive efforts, malnutrition persists as a critical public health concern, particularly in developing nations like Ethiopia. Concurrent occurrence of wasting and stunting poses severe consequences. Analyzing trends and factors contributing to this double burden is vital for evaluating and enhancing existing nutritional programs. Additionally, understanding the spatial distribution of malnutrition is crucial for targeted resource allocation, expediting progress towards optimal child growth. A 20-year trend and spatial analysis was conducted among 27,138 weighted samples of under-five children using EDHS (2000-2019). The data extraction was conducted between October 1 and November 1, 2023. STATA 18, ArcGIS Pro, and Sat Scan 9.6 were used for analysis. A logit-based multivariate decomposition analysis was used to identify contributing factors for the change in the double burden of wasting and stunting in the past 20 years. The statistical significance was declared at a P-value < 0.05. The double burden of wasting and stunting had shown a decline from 8.42% in 2000 to 3.31% in 2019. There is a clustered distribution of wasting and stunting (Moran's I = 0.0712, p-value = 0.0290). Significant clustering is detected in the Somali, Afar, and Tigray regions. Among the changes in the effect of the characteristics (coefficient), maternal education level [β = -0.0012, 95% CI -0.0021, -0.0006], wealth level [β = -0.0049, 95% CI -0.0223, -0.0014], family size [β = -0.0014, 95% CI -0.0132, -0.0009] and media access [β = -0.0027, 95% CI -0.0039, -0.0014] were found to be significant contributors to the reduction of the double burden of wasting and stunting over the past 20 years. Despite the significant progress observed in the past 20 years, the problem still requires urgent attention. Thus, improving maternal education and household wealth levels is crucial. Furthermore, enhancing access to and utilization of family planning services and media coverage will help alleviate the burden and end malnutrition. Additionally, deploying additional resources in hotspot areas is also recommended.